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Signs & concerns
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Signs & concerns
When to refer suspected Developmental Trauma for developmental therapy
Refer a child with suspected Developmental Trauma for developmental therapy when functional impairment is evident across settings and persists in a safe, stable environment — do not wait for a formal label. Address safeguarding and medical risks in parallel. Diagnosis and AbilityScore® are formed only at a Pinnacle centre.
Read the answer AnswerWhen should a doctor refer a child with suspected Down syndrome for developmental therapy?
Refer at the point of clinical suspicion, not after karyotype confirmation. Down syndrome carries a well-characterised developmental trajectory, so developmental therapy should begin in the neonatal period or earliest infancy, running concurrently with the medical work-up.
Read the answer AnswerWhen to refer suspected dyscalculia for developmental therapy
Refer when a child shows persistent, unexpected difficulty with number sense and arithmetic disproportionate to age and ability, unresponsive to good teaching over one to two terms. Dyscalculia is reliably identifiable from age 7–8; earlier numerical red flags warrant monitoring and a developmental check. Diagnosis is formed only at a Pinnacle centre.
Read the answer AnswerWhen should a doctor refer suspected dysgraphia for developmental therapy?
Refer a child with suspected dysgraphia when written-expression difficulty is persistent, unexpected for ability, and impairing — typically actionable from age 7–8 once formal writing demands are set. Refer promptly rather than waiting out the school year, and rule out vision, motor and instructional causes first.
Read the answer AnswerWhen should a doctor refer a child with suspected dyslexia for developmental therapy?
Refer when reading difficulty is persistent and unexpected despite adequate instruction and intact ability — typically lagging peers and not responding to a 6–8 week classroom boost. Formal dyslexia is identified from around age 7–8; before that, refer for early screening, not watch-and-wait. Only a clinician confirms it.
Read the answer AnswerWhen should a doctor refer a child with suspected Emotional & Behavioural Difficulties for developmental therapy?
Refer when emotional–behavioural difficulties are persistent (~6 months), pervasive across settings, and functionally impairing — and refer urgently for red flags such as regression, self-harm or safety risk. Exclude treatable and medical causes first; a structured developmental assessment then clarifies whether behaviour is primary or a co-occurring signal.
Read the answer AnswerWhen should a doctor refer a child with suspected Feeding & Eating Difficulties for developmental therapy?
Refer for developmental therapy once acute medical causes are excluded or stabilised and the difficulty is persistent and functional: faltering growth, mealtimes over 30 minutes or daily distress, severe food selectivity, prolonged tube/supplement dependence, or feeding difficulty with a co-occurring developmental condition. Refer urgently for medical review where aspiration or dysphagia is suspected.
Read the answer AnswerWhen to refer suspected FASD for developmental therapy
Refer at the point of suspicion, not at diagnosis. With confirmed or probable prenatal alcohol exposure plus any developmental concern, initiate developmental therapy in parallel with confirmatory assessment — a normal facial phenotype does not exclude FASD.
Read the answer AnswerWhen to Refer Suspected Fine Motor Delay for Therapy
Refer a child with suspected Fine Motor Delay when difficulty is persistent, falls below screening cut-offs, shows regression or asymmetry, or co-occurs with other developmental delays — early occupational therapy referral carries no downside. Diagnosis is formed only at a Pinnacle centre under clinician care.
Read the answer AnswerWhen to Refer a Child with a Genetic Syndrome for Developmental Therapy
For a suspected or confirmed genetic/chromosomal syndrome, refer for developmental therapy at the point of suspicion or diagnosis — not after delay appears. Therapy is anticipatory scaffolding; there is no minimum severity threshold. Medical red flags (seizures, feeding/swallowing risk, regression) need prompt medical referral first.
Read the answer AnswerWhen should a doctor refer a child with suspected Global Developmental Delay for developmental therapy?
Refer at first reasonable suspicion — you do not need a confirmed diagnosis. Once two or more developmental domains lag, or after a failed screen, regression, or persistent parental concern, refer for developmental therapy in parallel with aetiological workup. Therapy should not wait on diagnostics.
Read the answer AnswerWhen to refer a child with suspected gross motor delay
Refer for developmental therapy when a motor milestone window is clearly missed (e.g. no independent sitting by 9 months, no walking by 18 months), when skills regress, or when tone/asymmetry red flags appear — concurrently with medical work-up, not after it.
Read the answer AnswerWhen should a doctor refer a child with suspected Hearing Impairment for developmental therapy?
Refer the moment hearing loss is suspected — in parallel with audiology, not after it. Follow the 1-3-6 rule: screen by 1 month, confirm by 3, begin early intervention by 6. A failed screen, missed auditory milestone, or persistent parental concern each warrants concurrent developmental and speech-language referral.
Read the answer AnswerWhen should a doctor refer a child with suspected hypotonia for developmental therapy?
Refer early and in parallel — do not wait for an aetiological diagnosis. Any infant or child with persistent hypotonia plus functional impact (head lag, motor delay, feeding difficulty, fatigue) warrants concurrent physiotherapy and developmental therapy alongside neurological workup. Hypotonia is a sign, not a diagnosis.
Read the answer AnswerWhen to refer suspected Intellectual Disability for developmental therapy
Refer on suspicion, not on confirmation. A failed validated screen, multi-domain delay, skill regression, or significant adaptive deficit each warrant onward referral — with therapy initiated in parallel to aetiological work-up. Formal diagnosis of intellectual developmental disorder follows later under clinician-administered cognitive and adaptive testing.
Read the answer AnswerWhen to refer suspected motor planning difficulties for developmental therapy
Refer when motor-planning difficulty is persistent, functionally limiting and shows a clear plan–execute gap despite intact strength, tone and comprehension — and when no acute or progressive cause is suspected. A formal DCD label is not required to refer; early assessment improves outcomes. Diagnosis is made only by a clinician.
Read the answer AnswerWhen should a doctor refer a child with suspected Non-Verbal / Minimally Verbal Presentation for developmental therapy?
Refer on clinical suspicion, not after diagnosis. Key thresholds: no babble/gesture by 12 months, no words by 16 months, no two-word phrases by 24 months, or any regression at any age. Run audiology in parallel, and initiate therapy while differential workup proceeds — early AAC does not suppress speech.
Read the answer AnswerWhen to Refer Suspected ODD for Developmental Therapy
Refer when oppositional behaviour is persistent and cross-setting, when first-line parent guidance underdelivers, or when a developmental driver (language, ADHD, autism, regulation) may underlie the defiance. The referral is for clarification and skill-building, not the label itself.
Read the answer AnswerWhen to Refer Persistent Toe-Walking for Developmental Therapy
Refer when toe-walking persists beyond age 2, is idiopathic and habitual, shows fixed or reducing ankle dorsiflexion, or — most importantly — coexists with developmental, sensory or communication flags. Unilateral, asymmetric or regressive presentations need urgent neuromuscular evaluation, not therapy first. Idiopathic toe-walking is a diagnosis of exclusion.
Read the answer AnswerWhen to Refer a Preterm Child for Developmental Therapy
Refer high-risk preterm infants (<32 weeks, VLBW, or neonatal neurological insult) into early-intervention therapy at NICU discharge, and promptly at any age when corrected-age milestones, tone, movement, or feeding deviate. Early therapy in the neuroplastic window is preventive — refer on risk and early signs, not on a confirmed diagnosis.
Read the answer AnswerWhen to refer suspected Rett syndrome for developmental therapy
Refer for developmental therapy at the point of clinical suspicion — in parallel with genetic and neurological workup, not after it. The regression phase (6–18 months) is when speech/AAC, OT and physiotherapy best preserve function. Co-refer seizures and airway concerns to paediatric neurology urgently.
Read the answer AnswerWhen to refer a suspected School Readiness Gap for therapy
Refer a child approaching school entry (age 4–6) when a foundational gap persists across communication, cognition, motor, social-emotional or self-care domains and across settings. Refer sooner for regression or marked single-domain delay. Watchful waiting is appropriate only for mild, isolated, environment-linked lags.
Read the answer AnswerWhen should a doctor refer suspected selective mutism for therapy?
Refer when a child's failure to speak in specific settings persists beyond one month (excluding the first month of school), causes educational or social impairment, and isn't explained by a language disorder or unfamiliarity with the language. Selective mutism is anxiety-based — early referral, not watchful waiting, gives the best outcomes.
Read the answer AnswerWhen should a doctor refer a child with suspected Self-Regulation Difficulties for developmental therapy?
Refer when self-regulation difficulties are persistent (beyond ~4–6 weeks), pervasive across settings, and functionally impairing sleep, feeding, engagement or family life — after excluding treatable medical causes. Refer sooner when developmental red flags or caregiver distress co-occur. Only a clinician confirms findings.
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